Submit Your Completed/Saved Forms Below.
NOTE: All forms must be complete so please carefully review each page before submitting.
We hope that you will find the following information helpful in the scheduling process.
If you have any questions or need additional assistance with our process, please call our office at (502) 896-2606.
Initial Information and Questionnaires
Initial information required before scheduling an appointment is the New Patient Information Form below. Upon receiving the completed Patient Information forms from you, we will contact you by phone and guide you through the remainder of the process. We will arrange to email the questionnaires to be completed by parents and a teacher or teachers and returned to us to start your child’s medical record in our office. When we receive all completed forms, questionnaires, and any other records we’ve requested, our doctors will review the information and we will call you to schedule the recommended appointment.
Previous Medical Records
If there have been previous developmental evaluations, psychological testing, genetic work-ups, genetic laboratory testing, MRIs, CT Scans, or EEGs, please inform us as soon as possible. You will need to obtain all records prior to your appointment. They may be faxed to our office at (502) 896-0487.
Payment is due at the time of service. Acceptable payment types include Health Savings Account (HSA) or Flexible Spending Account (FSA) funds, most major credit cards, checks, or cash. While we do not participate in any insurance plans, we will provide itemized invoices so that you may submit a claim for out-of-network benefits to your individual insurance carrier. If there are insurance forms that you would like to request to be completed by our doctors, please include a self-addressed stamped envelope for us to return the forms to you. Square One does not fax or mail correspondence regarding reimbursement directly to insurance companies.
The Day of Your Appointment
When your appointment is scheduled, we request that you arrive 15 minutes prior to your appointment. If you are going to be more than 15 minutes late, we request that you notify us at (502) 896-2606. Please note that we do not book multiple patients for the same time allotments: your appointment time is uniquely for you.
No Show Policy
As a courtesy, our office makes reminder calls one business day before your scheduled appointment. Our no-show policy is to charge for an appointment missed without prior notification from you. The no-show fee for appointments not canceled 24 hours in advance is the same as the amount charged for the scheduled appointment.